Organizational constraints as root causes of role conflict

One down, fifty to go: managers' perceptions of their workload and how they cope with it to maintain their psychological health

Background

Like many other countries, healthcare services in Canada face numerous organizational changes with the main objective of doing more with less. The approach taken within different healthcare networks has brought about a reform in healthcare facilities in Quebec, leading to several mergers and eliminating over 1,000 managerial positions. As a result, this has placed a progressively heavier workload on the shoulders of the remaining managers. Research on mental health in the workplace has mainly focused with the workforce and generally neglects managers. However, studies have shown that workload is a risk factor for managers. Therefore, the objectives of our study are to (1) better understand the elements that make up a manager's workload and the factors that influence it and (2) identify the coping strategies used by managers to deal with their workloads.

Methods

Employing a qualitative approach, we analyzed 61 semistructured interviews through an abductive method, utilizing diverse frameworks for data analysis. The participants came from the same Quebec healthcare establishment.

Results

Our findings align with the notion that workload is a multifaceted phenomenon that warrants a holistic analysis. The workload mapping framework we propose for healthcare network managers enables pinpointing those factors that contribute to the burden of their workload. Ultimately, this workload can detrimentally impact the psychological wellbeing of employees.

Conclusion

In conclusion, this study takes a comprehensive look at workload by using a holistic approach, enabling a more comprehensive understanding of this phenomenon. It also allows for the identification of coping strategies used by managers to deal with their workloads. Finally, our results can provide valuable guidance for the interventions aimed at addressing workload issues among healthcare network managers in Quebec by utilizing the specific elements we have identified.

Hybridity enabled: A research synthesis of the enabling conditions for hybrid professionalism in healthcare

Hybrid professionals in healthcare organizations play a critical role, the characteristics, processes and implications of which have been thoroughly studied by scholars in the field. However, not as much attention has been paid to the conditions under which such roles might be taken by professionals entering the ground of management. This gap results into a lack of conceptual clarity and eventually ends being an obstacle in framing and ameliorating the tools needed to act such a role in its different phases. This is a research area worthy of a finer-grained understanding: the ability of organizations to effectively support role hybridization, in fact, is a requisite for professionals-managers' willingness to stay in the role and cope with the complexity that such a two-fold position entails, no matter what. Based on the results of a scoping literature review, this paper presents the enabling conditions for hybrid professionalism in healthcare, and proposes a classification of them into categories corresponding to different facets of hybrid role-taking: opportunities for interaction with management, tools supporting sense-making, and provision of delegation and autonomy. For each of these categories, organizational and management tools discussed in the literature are presented. The results of the study provide a road-map of the enabling conditions for hybrid professionalism that aims to be of practical convenience for managers and policy-makers in health care. Eventually, suggestions for organizational design and personnel management, as well as directions for further research, are highlighted.

Leading well and staying psychologically healthy: the role of resources and constraints for managers in the healthcare sector

PURPOSE

Maintaining a healthy and productive workforce is a challenge for most organizations. This is even truer for health organization, facing staff shortages and work overload. The aim of this study is to identify the resources and constraints that influence managers' mental health and better understand how they are affected by them.

DESIGN/METHODOLOGY/APPROACH

A qualitative approach was chosen to document the resources, the constraints as well as their consequences on managers in their day-to-day realities. The sample included executive-, intermediate- and first-level managers from a Canadian healthcare facility. A total of 62 semi-structured interviews were conducted. The coding process was based on the IGLOO model of Nielsen et al. (2018) to which an employee-related level was added (IGELOO).

FINDINGS

Results highlight the importance of considering both resources as well as constraints in examining managers' mental health. Overarching context, organizational constraints and the management of difficult employees played important roles in the stress experienced by managers.

PRACTICAL IMPLICATIONS

The results offer a better understanding of the importance of intervening at different levels to promote better organizational health. Results also highlight the importance of setting up organizational resources and act on the various constraints to reduce them. Different individual strategies used by managers to deal with the various constraints and maintain their mental health also emerge from those results.

ORIGINALITY/VALUE

In addition to addressing the reality of healthcare managers, this study supplements a theoretical model and suggests avenues for interventions promoting more sustainable organizational health.

Organizational culture and leadership behaviors: is manager's psychological health the missing piece?

Background

In a context where organizations struggle to attract and retain highly qualified workers, organizations need to prioritize the psychological health of employees as a retention factor. To do so, they need to provide a healthy work environment. As an integral part of the employee experience, managers are an important factor in employee retention. In past studies, researchers have focused on the importance of leadership in boosting employees' health without, however, considering factors encouraging such behavior in managers. Recently, some scholars have become interested in managers' health as a resource allowing them to adopt good leadership behavior. Indeed, these studies reveal interesting links between managers' emotional state and their behavior as leaders. Other studies, underscore the importance of considering the organizational context to better understand managers' psychological health that may influence their leadership behaviors. This study proposes to examine the complex process by which organizational culture influences managers' psychological health, which acts as a resource favoring the adoption of good leadership behaviors that are known to be constructive and have positive effects on employee.

Methods

Path analyses with the CALIS procedure SAS software, version 9.4 were conducted on a sample of 522 managers in three healthcare facilities in the province of Quebec, Canada.

Results

The results revealed that group culture is associated with the two indicators of managers' psychological health at work. The results also demonstrated that managers' psychological distress at work is positively related to transactional and laissez-faire leadership styles whereas psychological well-being at work is positively related to transformational and transactional leadership. Concerning indirect associations, there is a significant and positive indirect association between group culture and transformational leadership and there is also a significant and negative association between group culture and laissez-faire leadership. Finally, there is also an indirect association between hierarchical culture and transactional leadership.

Conclusion

Our study provides a more in-depth understanding of the relationship between organizational culture and leadership styles. More specifically, our findings highlight the benefits of implementing a group organizational culture to enhance psychological well-being, reduce psychological distress symptoms and promote good leadership behaviors.

Higher Education Students' Reflective Journal Writing and Lifelong Learning Skills: Insights From an Exploratory Sequential Study

Reflective journal (RJ) writing has been recognized as an effective pedagogical tool for nurturing students’ lifelong learning skills. With the paucity of empirical work on the dimensionality of reflective writing, this research sought to qualitatively analyze students’ RJ writing and design a generic reflection scheme for identifying dimensions of reflective thinking. Drawing on the theoretical scheme, another aim was to design and validate a questionnaire to measure students’ perceptions of their reflective writing experiences. The last aim was to quantitatively measure the link between perceived reflective writing and students’ tendency to use RJs in their future careers and personal lives. This exploratory sequential research included the following steps: First, experts’ review and analysis of 1312 RJ entries were attained. This step led to the design of a theoretical scheme of reflective writing and a 31-item questionnaire, used to gather data from 171 students (second-year pre-service teachers and third-year health managers). Partial Least Squares analysis corroborated the structure suggested by the theoretical scheme: two timelines–reflections regarding the current course assignments and those related to the student’s future development. Students’ tendency to use reflective skills in their future professional lives was highly connected to their long-term reflections, including learning experiences linked to academic, professional, personal, and multicultural development. The current study’s suggested validated generic scheme can be adapted and integrated into different curricula, thereby possibly increasing the potential of infusing RJ instructional strategies into higher education curricula, improving the quality of reflection in student journals, and promoting lifelong learning skills.

A qualitative study of hospital clinical staff perceptions of their interactions with healthcare middle managers

PURPOSE

The authors explored clinical staff perceptions of their interactions with middle management and their experiences of the uncongeniality of their working environment.

DESIGN/METHODOLOGY/APPROACH

Semi-structured interviews of clinical staff from an Australian public health service's Emergency, Surgery and Psychiatry departments. Volunteer interview transcripts were inductively coded using a reflexive thematic content analysis.

FINDINGS

Of 73 interviews, 66 participants discussed their interactions with management. Most clinicians considered their interactions with middle management to be negative based on a violation of their expectations of support in the workplace. Collectively, these interactions formed the basis of clinical staff perceptions of management's lack of capacity and fit for the needs of staff to perform their roles.

PRACTICAL IMPLICATIONS

Strategies to improve management's fit with clinicians' needs may be beneficial for reducing uncongenial workplaces for healthcare staff and enhanced patient care.

ORIGINALITY/VALUE

This article is among the few papers that discuss interactions with management from the perspective of clinical staff in healthcare. How these perspectives inform the perception of workplace uncongeniality for clinicians contributes greater understanding of the factors contributing to adversarial relationships between clinicians and managers.

Intraorganization conflicts of interest in hospitals adapting to a changing ecosystem

PURPOSE

Health systems function in an ecosystem that is turbulent and competitive because of demographic, economic, political, technological and lifestyle changes and sociopolitical influences, requiring hospitals to adopt comprehensive business strategies. Failure to do so may result in duplication, waste and deficits. This original article uses the prism of agency theory to examine differences in approach at two levels of hospital management and the consequent problems in the incorporation of necessary changes. Agency theory posits an inherent conflict of interest in organizations, including health organizations: the managers (agents) always aim to maximize their profit or personal interest instead of that of the owner or organization (principal), potentially causing difficulty in managing the organization. The aim is to generate recommendations for policymakers.

DESIGN/METHODOLOGY/APPROACH

The study is based on 30 semi-structured, in-depth interviews with key figures in the health system and on two levels of hospital management: senior managers and heads of selected departments. The analysis used a categorical qualitative methodology.

FINDINGS

The main findings are five key themes: views of business behavior, asymmetry of interests, asymmetry of information, transparency and cooperation between various levels of management and ambivalence toward business in hospitals. The two levels of management are clearly divided in terms of interests, information and activity, leading to difficulty in cooperation, efficiency and achievement of organizational goals.

ORIGINALITY/VALUE

Using agency theory, this study provides a systemic and organizational view of hospitals' management and environmental adaptation. Understanding the processes and increasing cooperation at various managerial levels can help make the system more efficient and ensure its survival in a dynamic market.

Linking work, occupational identity and burnout: the case of managers

Purpose

Based on identity theory, identity represents a set of meanings individuals hold for themselves based on their role in the society. Hence, they often engage in the process of verifying their role, seeking for the compatibility between these meanings and those perceived in a specific lived situation. If this compatibility is not perceived, this is likely to generate negative emotions. that could compromise their mental health. This paper examines the contribution of a weak verification of role identity in the explanation of managers ‘burnout. It aims at integrating identity theory into occupational stress research by analysing the proposition that a low level of verification of a salient role-identity will be associated with a high level of burnout. Hence, we consider identity salience as a moderating variable.

Design/methodology/approach

Cross-sectional data of 314 Canadian managers employed in 56 Quebec firms. Multilevel regression analyses were performed to analyse the data.

Findings

Low levels of verification of some standards of managers' role identity, mainly work demands and recognition which encompasses (monetary and non-monetary recognition, career prospects and job security) are significantly associated with managers' burnout. Furthermore, as predicted, results show that identity salience plays a moderating role on the relation between a weak verification of some standards of managers' role identity and burnout, mainly work demands, superior support and recognition.

Originality/value

This study proposes a relatively unexplored approach for the study of managers' burnout. It broadens the scope of research on workplace mental health issues, by the integration of the identity theory.